Health Care Careers

A big part of healthy living includes health care, be it from traditional health care providers such as physicians or alternative care providers such as acupuncturists. With people living longer and the world's population increasing, the need for health care professionals continues to grow. In fact, some of the fastest-growing professions that offer the highest pay and lowest unemployment rates are in the health care field, such as physician, physical therapist, and registered nurse.

Also contributing to this growth is the use of new medical technologies to diagnose and/or treat patients. These technologies will require specialists to operate and administer them, creating more jobs in the health care arena.

In addition to diagnosing and treating illnesses, most health care professionals now focus on wellness and prevention. Wellness is the state of being in constant good health while prevention means stopping illness before it starts. More and more, physicians are encouraging patients to adopt healthy habits, including eating well and exercising. Additionally, physicians and other health care providers are looking more closely at patients' lifestyles and emotional well-being to determine whether or not these may be contributing factors in their illnesses.

Understanding exactly what a health care professional does can help an individual decide what type of caregiver he or she should see for a particular ailment. This information can also bring a greater understanding of the vast network of health care professionals who work together to keep people healthy and well.

This chapter will look at professionals in health care that focus on the body—physicians, registered nurses, physical therapists, emergency medical technicians—as well as the mind—art therapists and psychologists, and even alternative practices, such as acupuncture.

ACUPUNCTURIST

Through the use of a Chinese medicine called acupuncture, acupuncturists diagnose, treat, and help prevent illness or disease. They also offer relief for chronic pain, drug addiction, nausea, and emotional problems. Some people who quit drinking or smoking seek acupuncture for help in stemming the cravings. More than two thousand years old, acupuncture involves the stimulation of certain points on the body. The stimulation is usually achieved by inserting fine needles into the skin. Other ways of stimulating acupuncture points include applying heat, electrical stimulation (when electricity is used to massage deep tissue or to relieve swelling), pressure, which is called acupressure, friction, or suction.

Health Care Careers: Words to Know

Accredit:

To recognize an educational institution for having the standards that allows graduates to practice in a certain field.

Advocate:

A person who defends the cause of another.

Allopathic:

The system of medical practice making use of all measures that have proved to be effective in the treatment of disease.

Associate's degree:

Degree granted from two-year college institutions.

Bachelor's degree:

A four-year college degree.

Bedside manner:

A physician's ability to put a patient at ease and communicate effectively.

Congenital:

Existing at birth.

Continuing education:

Formal schooling above and beyond any degree that is often required of medical professionals in order to keep practicing in their specific field.

Diagnostic:

Used to recognize a disease or an illness.

Dissertation:

An in-depth research paper.

Fellowship:

Advanced study and research that usually follows a medical residency.

Geriatric:

Elderly.

Holistic:

Treating both the body and the mind.

Internship:

Supervised practical experience.

Licensed:

Authorization to practice a certain occupation

Master's degree:

A college degree that ranks above a four-year bachelor's degree.

Manual:

Involving the hands.

Musculoskeletal:

Relating to the muscles and bones.

Osteopathy:

A system of medical practice based on the theory that disease is due chiefly to mechanical misalignment of bones or body parts.

Radiation:

The energy sent out when changes occur in the atoms of an object.

Registered:

To complete the standards of education issued by a state government to practice a certain profession.

Residency:

Advanced training in a medical specialty that includes or follows a physician's internship.

Specialize:

To work in a special branch of a certain profession.

Ultrasound:

The use of high-frequency sound waves that forms an image to detect a problem in the body.

According to traditional Chinese medicine, every person has vital energy, called Qi (also referred to as chi; both are pronounced "chee"), flowing through his or her body. This invisible energy, which travels along twelve major pathways called meridians, can become imbalanced, creating areas of deficient (less) and excess (more) Qi. It is thought that imbalanced Qi can cause illness. Acupuncture works to restore the balance of Qi by stimulating certain points on the body that affect the flow of Qi. As a result, Qi is sent to areas of deficiency and removed from areas of excess, which allows the body to function at its best.

During a session, an acupuncturist will first talk with patients about any physical or emotional problems they may be experiencing and will also observe the patients' movements, examine their bodies, and check pulse rates at different points on the wrists. This helps the acupuncturist to make a diagnosis. The acupuncturist will then stimulate certain points on the body, usually with the needles. Some acupuncturists will stay at the patient's side during the whole session in almost continuous contact with the patient. Others will insert the needles and leave the room, allowing the patient to rest.

An acupuncturist, who typically works in a health spa or private practice, must be familiar with all of the acupuncture points (more than 365) on the body and which parts of the body each affects. For example, stimulating a point on the leg may help with headaches or stomachaches. When providing treatment, the acupuncturist will only stimulate the points he or she believes will benefit that specific patient.

Training to Be An Acupuncturist

To become an acupuncturist, a person usually attends a three-year program in acupuncture and Asian medicine, which includes practical (handson) experience in a clinical setting. There are both accredited and non-accredited schools (accredited schools must adhere to certain standards that qualify its students for professional practice). Shorter programs do exist that only require 50 to 200 hours of study in acupuncture. These programs, which are not accredited, are usually taken by medical professionals who want to incorporate acupuncture into their practices.

In more than half of U.S. states, an acupuncturist must be licensed to practice. To become licensed, certain requirements, which can vary among states, must be met by a candidate.

These requirements may include providing proof of the satisfactory completion of a formal study program, having practical experience, and passing a licensing examination given by the state.

If a state does not require licensing, an acupuncturist usually takes the certification examination offered by the National Commission for the Certification of Acupuncture & Oriental Medicine (NCCAOM). A person who completes one of the shorter programs in acupuncture cannot qualify for taking the NCCAOM examination or state licensing examinations.

ART THERAPIST

Using different art forms and a variety of craft activities, art therapists treat emotional, mental, and physical disabilities in patients. An art therapist will engage a patient in the artistic process through drawing, painting, creating collages, taking photos, sculpting, or other art forms to help patients express their feelings and to promote self-awareness. This form of therapy is especially useful when dealing with people who are unable to talk directly about their problems.

Often times, an art therapist is able to make a breakthrough with a patient's therapy when efforts by other therapists have failed to help the patient move forward.

A typical session with an art therapist may involve the therapist directing a patient to work on a drawing or painting of a scene that mirrors something that is happening in that patient's life. In a group setting, the therapist may have patients work together on a mural; an exercise of this nature can help patients learn to interact with others in a productive manner.

A profession that began in the twentieth century, art therapy became popular in the 1930s as art instructors recognized the value of children's artwork as a representation of their emotional and mental states. At the same time, psychiatrists (doctors who specializes in mental illness) began to look at artwork done by their patients in order to determine whether or not a link existed between the art and a patient's illness.

Art therapy is used to treat people of all ages, races, and ethnic backgrounds. It can help people with problems of a developmental, educational, medical, social, or psychological nature. Oftentimes, art therapy will be employed in a number of settings, ranging from a private therapist's office to a school to a hospital. Art therapy can be used with individuals, couples, families and groups of people with similar issues.

Whether art therapists work in hospitals, shelters, or schools, they will usually work with teams of physicians, psychologists, registered nurses, social workers, and teachers in order to best serve a patient. With the combined knowledge of all of these individuals, art therapists are able to come up with effective mental health programs. Art therapists working in a private office may consult with these other professionals even though they may be their patient's primary therapist.

Training to Be an Art Therapist

Formal training for art therapists involves a four-year college degree in either art therapy or psychology with a concentration in art therapy, as well as a master's degree in art therapy. One needs a master's degree to be a registered art therapist. One can get a job in art therapy without a master's degree, but not be an actual therapist. To become a registered art therapist (A.T.R.), one thousand hours of direct client contact hours must be completed in a supervised setting. On a personal level, art therapists are, ideally, sensitive to people's needs and expressions. Patience, attentiveness, and good people skills are all characteristics of an effective art therapist. Furthermore, a solid understanding of psychology (the study of the mind and behavior) and of different art forms is necessary.

CHIROPRACTOR

Chiropractors are well known for treating patients who are experiencing back and neck problems. In general, they address ailments of the muscular, skeletal, and nervous systems. They handle problems with these bodily systems through the manipulation and adjustment of certain areas of the body, particularly the spinal column. While chiropractic (derived from the Greek word "cheir" meaning "hand," and "prakticos" meaning "skillful use of") is considered an alternative medicine, it is the fourth largest health profession in the United States.

Daniel David Palmer (1845-1913) founded the practice of chiropractic in the 1890s. He believed that disease is the result of interference with the normal function of the nervous system. He determined the interference is caused by subluxation, or the slight dislocation of two vertebrae in the spinal column. The subluxation impairs nerve function that in turn upsets the functions of other parts of the body influenced by those nerves. According to chiropractors, this leaves the body more open to disease. Chiropractic addresses subluxation by manually realigning the spinal column. Once the vertebrae are realigned, nerve function should improve and allow the body's natural healing process to work better.

When treating a patient, a chiropractor takes into account the patient's history, current lifestyle, and response to treatment. Therefore, communication between chiropractor and patient is an important factor. A chiropractor will ask patients about their exercise, dietary, and sleep habits, their genetics, and their living and work conditions. Chiropractic treatment works to improve the patient's overall well-being.

As well as manipulating and adjusting the spinal column with their hands, chiropractors may use other forms of treatment such as massage, ultrasound, and water, heat, light or electric therapies. They may also counsel their patients in proper nutrition and healthy living. They do not perform surgery or prescribe drugs for their patients. An interesting fact is that chiropractors are trained in obstetrics (the branch of medicine relating to the care of women during pregnancy and childbirth) and gynecology (the branch of medicine relating to treatment of the female reproductive system) and have the ability to deliver babies, however, most chiropractors never use this training. Also, some chiropractics can lawfully perform minor surgery in certain states.

Training to Be a Chiropractor

To study chiropractic care, a person may attend a chiropractic college. Palmer founded the first school of chiropractic in Davenport, Iowa, in 1897. To qualify for admittance to a chiropractic college, a person must have a minimum of two years of college course work that includes classes in biology and chemistry. Some states do require chiropractors to have a bachelor's degree (a four-year college degree), and in the future, chiropractic colleges will probably require bachelor degrees to qualify for admittance. The chiropractic programs are full-time for four years. Upon satisfactory completion of a chiropractic program, students earn the doctor of chiropractic degree and the initials D.C. may follow their names.

"STRAIGHTS" AND "MIXERS"

There are two major categories of chiropractors: the "straights" and the "mixers." The straights generally perform chiropractic in the traditional manner, focusing on the manipulation and adjustment of the spinal column. The mixers, on the other hand, employ a variety of therapies in their chiropractic work, including acupressure, massage, nutritional counseling, or physical therapy. Thus they "mix" straight chiropractic with other therapies. Only about 15% of practicing chiropractors graduating today are considered "straights."

In order to practice after graduation, a chiropractor must pass a state board examination to become licensed. Continuing education is required for chiropractors to maintain their licenses. Areas of specialty do exist for chiropractors. These include neurology, orthopedics, nutrition, sports injuries, or internal disorders. Chiropractors typically work in solo or group practices or for other chiropractors. Some work in hospitals or clinics; others teach or conduct research.

DENTIST

Seeing a dentist on a regular basis is an important part of preventive dental care. Dentists today are focusing more and more on preventive care (that is, taking care of teeth before there is a problem) in order to help people avoid having to undergo complicated dental procedures for painful conditions, such as gum disease. In addition to providing people with advice on preventive dental care and good oral hygiene, dentists diagnose and treat problems of the teeth and gums. This ranges from cleaning teeth to filling cavities, taking X rays, and repairing damaged teeth.

A typical visit to a dentist will entail the dentist using a variety of tools, such as X-ray machines and instruments (mouth mirrors and probes), to examine the teeth. After evaluating a patient's X rays, a dentist will treat problems, for example tooth decay, and clean the teeth. The dentist may then advise a patient as to how to improve the home dental care routine, offering advice on brushing or flossing techniques as well as recommending new products, such as a new oral rinse.

Other services, like sealing children's teeth to prevent cavities, pulling teeth, and making dentures (false teeth), are familiar tasks to dentists. Dentists also provide cosmetic services, including whitening the teeth.

Most dentists work in either private practice or in group practices with other dentists who provide similar or different dental services. These dentists are often supported by dental hygienists (who clean teeth and provide instruction on good oral care) and dental assistants (who assist the dentist and the hygienist in procedures). Other dentists may work in large clinics. Still other dentists may become instructors or researchers.

Dentists, like medical doctors, often specialize in treating different populations of people, like pediatric dentists who treat children, or provide particular dental services, such as orthodontics, periodontics, or oral surgery. Orthodontists, the largest group of specialists, concentrate on straightening the teeth. Periodontists treat the gums and the bone supporting the teeth. Oral surgeons operate on the mouth and the jaws.

Training to Be a Dentist

Training for dentists begins with a bachelor's degree (four-year college degree), which usually includes a course of study that focuses on the sciences, such as biology and chemistry. Applicants to dental schools then take

the Dental Admissions Test (DAT). Once students have entered four-year dental schools, they study in the classroom and laboratory. From there, dental students treat patients in dental clinics under the supervision of licensed dentists. After students graduate from dental school with degrees of doctor of dental surgery (D.D.S.) or doctor of dental medicine (D.M.D.), they must pass written and practical licensing exams in order to practice dentistry.

Specialists, such as oral surgeons and pediatric dentists, usually must go through an additional two to four years of postgraduate education. Many states then require that a specialty license be obtained before a dentist may practice as a specialist.

In addition to educational requirements, the best dentists are those with good diagnostic ability and manual (hand) skills. A good visual memory, excellent judgment of space and shape, and strong communication skills are also essential.

DIETITIAN

Preventing disease and illness before it begins has a lot to do with what people eat. With more and more people now watching what they eat, the need for dietitians has increased greatly.

Dietitians can help prevent and treat illnesses by promoting healthy eating habits, planning nutrition programs for schools and hospitals, and advising patients as to how they can improve their diets.

Dietitians work in a variety of settings, depending upon the type of work they do. Most hospitals, schools, and nursing homes work with dietitians to help map out healthy meal plans, educate people about the importance of good nutrition, and create special diets for people with special needs (such as diabetics who must carefully control the amount of sugar they eat).

Dietitians work closely with dietetic technicians (who assist dietitians), nutritional counselors (who typically counsel individuals on eating habits and nutritional problems), and food-service personnel (who help prepare and serve meals). There are four main types of dietitians:

CLINICAL DIETITIANS. Clinical dietitians can be found working in institutions such as hospitals and nursing homes. These professionals will look closely at the needs of the patients or residents and develop a nutritional program (including planning meals) that will meet the different needs of all the patients. Clinical dietitians monitor the effectiveness of their programs and are constantly seeking ways to make sure that people's nutritional needs are being met. Often, these dietitians consult with doctors and other health care professionals to ensure that a patient's medical care and nutritional plan complement one another. It is not uncommon for clinical dietitians to specialize in treating specific patient populations, such as pediatric, diabetic, or geriatric (elderly).

COMMUNITY DIETITIANS. Community dietitians offer nutritional counseling to people in a certain community or to members of a certain organization in order to help these people prevent disease and maintain their health. These dietitians can be found working in community health care clinics, health maintenance organizations (HMOs), and home health agencies. Like clinical dietitians, community dietitians evaluate dietary needs by listening and talking to individual patients about their lifestyles. The dietitian then develops nutritional care plans for the patients and advises their families. The advice a community dietitian provides can range from tips on grocery shopping to instruction on food preparation.

CONSULTANT DIETITIANS. Many consultant dietitians see patients in their own private practices or work for an established health care facility. In either case, these dietitians most often provide nutritional screening for patients. Nutritional screening is a process in which dietitians evaluate the eating habits of their patients. Based on the results of screenings and patients' concerns, consultant dietitians can counsel patients how to lose weight, reduce their cholesterol, or adopt a high-fiber and low-fat diet. Consultant dietitians may also work with supermarkets, sport teams, and food manufacturers.

MANAGEMENT DIETITIANS. Management dietitians are experts at planning meals for large numbers of people, such as those found in major health care facilities, corporate cafeterias, prisons, and schools. Hiring, training, and supervising other dietitians and food-service workers are just part of the management dietitian's job. They also have to handle the budgeting for and purchasing of food and supplies and make certain that safety and sanitary regulations are followed.

Training to Be a Dietitian

Dietitians must have a bachelor's degree (four-year college degree) with a major in dietetics, foods and nutrition, food-service systems management, or a related area. Most bachelor's programs require students in dietetics to serve internships or have supervised work experience. Some dietitians also hold a master's degree in nutrition science. Dietitians can become registered dietitians (R.D.) by passing a certification exam that may be taken only after completing their education and supervised work experience or internship.

EMERGENCY MEDICAL TECHNICIAN (EMT)

When a medical emergency occurs, such as a car accident or a heart attack, emergency medical technicians (EMTs) are most often the first to arrive at the scene. Working in teams of two, EMTs drive ambulances with special

equipment that allows them to examine patients and treat injuries and illness. After EMTs determine the seriousness of an emergency, they give people immediate medical care. They must follow strict guidelines when treating their patients. Once treatment has been given, one EMT continues to monitor and treat the patient in the ambulance while the other EMT drives to the nearest hospital.

There are three skill levels for an EMT: EMT-Basic; EMT-Intermediate; and EMT-Paramedic. The differences among them revolve around what type of emergency care they are trained for and allowed to give. All EMTs can do the following:

• help with childbirth
• control bleeding and bandage wounds
• restore breathing and administer oxygen
• treat victims for shock and heart attack
• treat poison and burn victims
• use an automated defibrillator (equipment that uses an electric shock to restore a regular heartbeat)

EMT-Intermediates have more training than an EMT-Basic so they can use more sophisticated equipment and procedures to treat medical emergencies. EMT-Paramedics have the most training and are able to give a victim the most extensive care. This includes administering drugs, reading electrocardiograms (EKGs, or machines that monitor heart problems), and performing endotracheal intubations (insertion of a breathing tube down the throat).

When EMTs arrive at a hospital, they give the emergency room doctors information regarding the patient, including the patient's medical status and any procedures that have been performed on the patient. Once the patient is at the hospital, the EMTs' job is done, until they are called to help in another emergency.

EMTs' work can be very challenging because the workday usually involves life-and-death situations. Along with the challenges and the excitement, however, comes stress and sometimes danger. EMTs must remain calm in emergency situations, as well as calm others at the scene. If EMTs are called to handle a victim who's had a drug overdose or a patient suffering from a mental illness, the EMTs may have to deal with angry and/or violent reactions from their patients.

Training to Be an EMT

In order to become an EMT, one must be at least eighteen years old and have a high school diploma and a valid driver's license. The training an EMT must undergo is different for each skill level. Moving from one level to the next involves a certain amount of classroom work and field work, as well as written and practical examinations. In order to become registered, or certified, one must pass an examination that is given by the National Registry of Emergency Medical Technicians. Many communities colleges offer courses in EMT Training.

EMT-Basic requires 110 to 120 hours of work in the classroom as well as ten hours interning in the emergency room of a hospital. Upon completion of the EMT training program, graduates must pass the National Registry's written and practical exam.

Moving from EMT-Basic to EMT-Intermediate requires more classroom work, usually between 35 and 55 hours. It also requires another examination, as well as a certain amount of practical experience in the field.

Most EMT-Intermediates go on to become EMT-Paramedics. This requires still more education and training. Training can last from 750 to 2,000 hours. Once training is completed, a person must take yet another written and practical exam, as well as gain more experience in the field.

All EMTs must reregister every two years to continue working in the field. To do so they must continue to take classes and learn about advances in the equipment they use and the medicines they give their patients.

HEALTH SERVICES ADMINISTRATOR

Hospitals and other health care facilities, such as nursing homes, health clinics, HMOs (health maintenance organizations), and group practices are places where people expect to receive good medical care. At these facilities, there is usually one person who makes sure everything is running smoothly. That person is the health services administrator. The job of a health services administrator (also referred to as health services director) involves the many responsibilities that are part of running a health care facility.

Health services administrators oversee the day-to-day operations of the facility, which requires a tremendous amount of planning, and organization, as well as financial management. They ensure that all patients are receiving the best possible health care at all times.

Health services administrators must also supervise a staff of assistant administrators, who are in charge of different areas, from food service and housekeeping to marketing and public relations. Public relations and marketing are important to a health care facility. These departments reach out to the community to learn how to improve the facility for the people who need and use it.

A large part of a health services administrator's job is planning for the future. Health care is always changing as new technologies are constantly being developed. Health services administrators need to stay aware of these changes in order to make improvements in the facility.

They need to decide how to best spend the facility's money, either by hiring more staff, buying new equipment, or expanding the facility. Once a decision is made as to how to spend the money, health services administrators also must be sure that the improvements don't cost more than the facility has to spend.

All health care facilities must follow government regulations. These regulations are enforced to make sure that people are receiving quality health care. Health services administrators must be sure their facilities meet the standards set by government agencies, as well as insurance companies, who routinely check up on facilities and evaluate their performance.

There are many opportunities for health services administrators since there are many different types of health care facilities throughout the United States. Work settings range from small clinics to large hospitals. The amount of responsibility for health services administrators depends on the size of the facility in which they work.

Training to Be a Health Services Administrator

In order to pursue a career as a health services administrator, one should have a bachelor's degree (four-year college degree) with a major in social sciences, health administration, or business administration. A bachelor's degree enables one to apply to a master's program in hospital administration, public health, or health administration. Licensing is not required for all health services administrators. Some states require that those working in nursing homes or long-term care facilities become licensed by passing a written exam.

Health services administrators must be able to deal with people effectively, communicate well, and handle many tasks at once. While there are assistants to take some of the responsibility, health services administrators are usually the only ones able to make important decisions. At a hospital or other health care facility, this can happen at any time, seven days a week, twenty-four hours a day.

MENTAL HEALTH COUNSELOR

PATIENT ADVOCATE

Patient advocacy is a relatively new field in health care. Patient advocates are people who help patients and their families when patients believe there are problems with the quality of health care they are receiving. When patients feel they have been treated poorly, patient advocates will meet with them and listen to their concerns. Patient advocates may then speak with the health services administrators to discuss a solution to the problem.

The job of a patient advocate is not to determine whether an actual problem exists. Rather, patient advocates provide a forum for patients to express their concerns. Sometimes, patient advocates solve problems just by listening to the patients. Other times, patient advocates work with health services administrators to develop a resolution to the problem.

Patient advocates are also responsible for collecting information regarding patient problems and writing reports that can be used to make improvements to the health care facility. By working with patients and health services administrators, patient advocates help both sides understand each other better. By helping patients with their problems, patient advocates can prevent possible lawsuits against their health care facility. Sometimes, a change in policy will result from the work of patient advocates.

Since it is a new field, there are no educational requirements for patient advocates. It is possible to work in the field with a high school diploma or an associate's degree (degree granted from two-year college institutions). Some patient advocates enter the field with on-the-job training or by volunteering. However, it is recommended to earn a bachelor's degree. The most important thing for those who wish to pursue a career as a patient advocate is to have experience working in a hospital or another type of health care facility.

Patient advocates must be compassionate and sympathetic to patients who are often angry or frustrated with the way they've been treated. This requires that patient advocates have good communication skills and like working with people.

Mental health counselors help people work through problems in their lives and improve their overall mental health. They counsel patients with problems associated with most areas of life, including family, career, or school, as well as poor self-esteem, abuse, suicidal tendencies, drug and alcohol addiction, or stress. Patients may vary in age from small children to the elderly.

Most mental health counselors specialize in certain age groups, such as adolescents or adults, or they may specialize in areas, such as abuse or marriage. Mental health counselors can provide individual, group, or family counseling. They may work in private practice or at community or social services agencies, drug rehabilitation centers, group homes, health maintenance organizations, mental health clinics, prisons, or schools.

During a session, a mental health counselor talks with a patient about any concerns that the patient may have. This may sound easy, but it can be hard since many people find it hard to talk about their feelings. It is the responsibility of the counselor to make the patient feel comfortable and to keep a dialogue going between them. A counselor must also be very patient for it may take a long time for a person to open up or to want to make life-changes.

Based on the patient's problems or concerns, a mental health counselor will develop a treatment plan for the patient. During treatment the counselor will keep records of the patient's progress. The goal in mental health counseling is to have a patient work through problems and regain control of his or her life. Mental health counseling also places emphasis on preventive care; therefore, counselors try to develop ways to teach people about maintaining good mental health.

Training to Be a Mental Health Counselor

To work as a mental health counselor, a person is required to obtain a master's degree (a college degree that ranks above a four-year bachelor's degree) in counselor education. Mental health counseling programs are accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP). To graduate from an accredited program, a person must successfully complete 48 to 60 semester hours of course work as well as gain a certain amount of practical experience. Doctoral programs (programs that grant degrees beyond the master's degree level) are also available, which is a good foundation for those interested in conducting research.

The National Board for Certified Counselors (NBCC) offers certification to all counselors, whether their particular state requires certification or not. To be certified by the NBCC, a person must have graduated from an accredited master's program, practice as a counselor in a supervised, professional setting for two years, and pass the certification exam given by the NBCC called the National Counselor Examination for Licensure and Certification.

OCCUPATIONAL THERAPIST

SUBSTANCE ABUSE COUNSELORS

Substance abuse counselors focus on counseling people with alcohol and drug addictions. These counselors evaluate their patients' conditions, devise treatment programs with the help of other medical professionals, and counsel their patients in individual or group therapy sessions. Recovery from drug or alcohol addiction is a lifelong struggle that may have periods of relapse; therefore, substance abuse counselors must have compassion and patience. They may work in private practice or at drug rehabilitation centers, hospitals, or government agencies.

These counselors have strong knowledge of drugs and their effects on the human body, both mentally and physically. They are trained in the characteristics of drug and alcohol addiction. Infact, some substance abuse counselors have firsthand knowledge of the destructive effects of the drugs and the difficulties of recovery because they are former addicts themselves.

Training to Be a Substance Abuse Counselor

A master's degree is not required to become a substance abuse counselor, but it is preferred. Certification is available, which is recommended since most employers will only hire certified substance abuse counselors. Standards for certification usually include supervised practical experience as a substance abuse counselor for two years, two- to three-hundred training hours, a case presentation, and an examination. A Master Addictions Counselor (MAC), which is the highest level of certification in this field, must have a master's degree, three years' practical experience, five hundred training hours, and an examination.

Having a disabling condition, such as arthritis, paralysis, cerebral palsy, muscular dystrophy, or mental illness, can mean having to learn or relearn how to perform routine activities for daily living and working. Occupational therapists, or registered occupational therapists (O.T.R.), help patients suffering from these conditions set and reach goals for accomplishing activities such as eating, dressing, and writing. Occupational therapists also design and make special devices that help patients adapt to their home and work space and communicate with others more effectively. A major goal of occupational therapy is to have the patient become more independent. Occupational therapists also strive to improve the patient's quality of life.

Some techniques employed by occupational therapists include physical or mental exercises and the use of computer programs that help improve a patient's problem-solving, decision-making, and memory skills. For example, if a patient suffers from memory loss, an occupational therapist will instruct the patient in exercises that work to improve memory and prevent forgetfulness. An important part of treatment is patient participation. Patients are expected to use what they learn in therapy in real life. Many activities, then, are planned that require the active participation of the patient. In creating and using various techniques, occupational therapists must be imaginative and have a great deal of patience.

Occupational therapists work with other health care professionals on the rehabilitation of a patient. Rehabilitation is the general name given to training and therapy techniques designed to help a person return to normal daily activities. A physician heads the rehabilitation process of the patient and refers the patient to an occupational therapist. The occupational therapist evaluates patients, plans treatment programs with reachable goals for them, and monitors their progress.

Work settings for occupational therapists can vary from hospitals to schools or rehabilitation centers to the homes of their patients. Some may choose to work specifically with children or with the elderly. Others may work primarily with mentally ill patients or with patients with specific physical disabilities, such as cerebral palsy. Occupational therapists who specifically help patients with workplace needs are called industrial therapists. Occupational therapists may also teach or conduct research.

Occupational therapists work with occupational therapy assistants, or certified occupational therapy assistants (C.O.T.A.), who aid in the treatment of the patients. Occupational therapy assistants do not evaluate patients, but they do administer the treatments devised by occupational therapists and document the patients' progress.

Training to Be an Occupational Therapist

To become an occupational therapist, a person may acquire a bachelor's or master's degree in occupational therapy or, a person with a bachelor's degree in another field may also enter a post-bachelor's certificate program in occupational therapy. During a program, a student studies behavioral, biological, and physical sciences as well as completing practical experience in the field. Occupational therapy programs receive accreditation from the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association.

In order to practice, an occupational therapist must be licensed. Candidates who successfully complete an accredited occupational therapy program may take a national certification examination given by the American Occupational Therapy Certification Board. After passing the exam, they become registered occupational therapists. Continuing education is necessary for all occupational therapists to keep on top of the latest advancements in the field.

OPTOMETRIST

When people have problems with their vision, they may go to see an optometrist. Optometrists, also referred to as doctors of optometry, examine patients' vision and treat any eye infections or diseases. During an eye examination, optometrists give patients different tests using instruments or merely observing a patient's eyes. They test for sharpness of vision, depth perception, color perception, and ability to focus. Once the tests are complete, optometrists review the test results and prescribe treatment. Most times, optometrists prescribe corrective lenses, such as glasses or contact lenses, for vision problems. Sometimes, they use vision therapy to treat a problem. If an infection or disease is present, optometrists prescribe medication. Optometrists do not, however, perform eye surgery on patients. This job is performed by ophthalmologists, physicians who specialize in eye health and can perform surgery on the eyes.

According to the American Optometric Association, two-thirds of all optometrists have their own private practice. This means they are not only treating patients, but they are also running a business. Running a business usually involves hiring people, taking care of the finances, finding new patients, updating equipment, and investing in new technology. There is a growing trend among optometrists to work together, sharing a practice with one or more optometrists. This allows the optometrists to share the responsibilities of running a business or to have the flexibility to work in other environments, such as clinics or vision care centers.

There are other career options for optometrists who do not open a private practice. Some optometrists choose to specialize in other areas of the field. They may work specifically with children or the elderly, or they may focus on improving the vision of people working in certain environments who are vulnerable to eye problems on the job. Some optometrists even specialize in sports vision, helping athletes with any vision problems. In addition, optometrists may also work in hospitals, at HMOs, or for ophthalmologists. A smaller number of optometrists choose to work as consultants for insurance companies or other companies, conduct research, or teach.

Training to Be an Optometrist

In order to become an optometrist, one must receive a doctor of optometry from an optometry school that is accredited by the Council on Optometric Education of the American Optometric Association. A person must have a bachelor's degree (four-year college degree) from a college or university in order to apply to an optometry program. Optometry schools accept students who have studied math and science in college and who have passed the Optometry Admission Test.

A student in an optometry program, which lasts four years, will do classroom and laboratory work as well as have practical training. After completing optometry school, it's necessary to take another examination given by the state in which the school is located in order to receive a license to practice optometry. Optometrists must continue their education so that they can renew their license every one to three years. If optometrists wish to specialize in other areas, teach, or conduct research, postgraduate work is necessary.

PHARMACIST

Prescription drugs, which are prescribed by physicians or other health care practitioners, are not available over the counter. Pharmacists, usually in drugstores, dispense them. This is to ensure proper dosages are given to patients with accurate instructions on how to administer the drug. Pharmacists also inform patients of side effects or possible interactions, either with food or other drugs, that can cause problems. If pharmacists work in hospital settings, they fulfill requests from physicians for drugs for their patients. They are also available to advise physicians and other staff on the characteristics of a particular medicine.

Pharmacists may have to mix preparations to form certain prescriptions, which is called compounding, but most drugs sold today by pharmacists are made by drug companies.

Pharmacists are required to know how a drug should be used, what it is made of, and what effect it gives when taken. They keep records of the prescriptions they fill, usually in a computer database. As well as keeping their business organized, these records allow pharmacists to warn patients if their records show that a patient has filled a prescription that is going to interact negatively with another drug he or she is already taking.

Even though they are primarily responsible for dispensing prescription drugs, pharmacists do have knowledge of over-the-counter drugs (drugs that are available to the public without a prescription, such as aspirin or certain cold medications) and can advise drugstore customers on their proper usage. They also have knowledge of any medical equipment being sold in the drugstore. In some drugstores, pharmacists may have the responsibility of stocking other nondrug-related merchandise, such as cosmetics, and hiring and managing personnel.

In addition to dispensing drugs and fielding drug questions from hospital staff, pharmacists working in hospitals usually monitor patients' drug treatments during their stay and order medical supplies. If patients have questions about the drugs they are taking, hospital pharmacists are available to answer their questions, too. Other areas in which a pharmacist may be employed include the pharmaceutical industry, home health care, or research facilities.

Training to Be a Pharmacist

To become a pharmacist, a person must graduate with either a bachelor's degree in pharmacy or a doctor of pharmacy (Pharm.D.) degree. The bachelor's degree in pharmacy is a five-year program and the doctor of pharmacy degree is a six-year program. However, by the year 2004, it is planned that all accredited programs will only offer the doctor of pharmacy. Some pharmacy programs accept students directly out of high school. For others, there is a prerequisite of one or two years of undergraduate college classes. Master's and Ph.D. (doctoral) degree programs in pharmacy are also offered by some schools.

Before pharmacists can begin to work, they must become licensed by the state in which they will be working. There are certain requirements a person must meet for licensure. Those include successfully completing a program in pharmacy from an accredited college, taking and passing a licensing examination given by the state, and completing an internship supervised by a licensed pharmacist. Like most health care fields, continuing education is very important. In fact, in order to maintain a license in some states, continuing education is required.

PHYSICAL THERAPIST

Physical therapy is a very popular, competitive career with many job opportunities. Physical therapists evaluate and treat patients who suffer from the effects of injuries or diseases. They have important roles in the rehabilitation of their patients. They work to relieve symptoms, correct existing problems, and prevent further physical disabilities associated with a patient's condition. Their patients may suffer from diverse conditions such arthritis, cerebral palsy, back pain, head injuries, or fractures.

Physical therapists design specific treatment programs for their patients, depending on the patient's injury or disease. For example, if a patient has lower back pain, the physical therapist may design a program that includes hot packs and traction. They are responsible for outlining the program and its desired outcome in a treatment plan. It is required in most states for a patient to be referred to a physical therapist by a physician. The referral may give the physical therapist the freedom to devise the patient's treatment program or the physician may give specific treatment instructions.

Some treatments physical therapists use to address their patients' conditions include exercise, massage, ultrasound, hydrotherapy (water therapy such as whirlpools), electrical stimulation (when electricity is used to massage deep tissue or to relieve swelling), hot packs, ice, paraffin (hot wax), and traction (when a person's body is gently pulled by a machine to stretch muscles and increase circulation). During the first visit, a patient is evaluated and a treatment program is developed. On following visits, the patient receives treatment by the physical therapist, a physical therapy assistant, or aide.

During the evaluation of the patient, the physical therapist performs diagnostic tests. These tests provide the therapist with information on muscle function, strength, and range of motion, balance, coordination, and areas of weakness, and whether the patient has suffered any brain damage. This information, along with the patient's medical history and diagnosis from the patient's physician, helps the therapist devise an effective treatment program and monitor the patient's progress.

Physical therapists work in a variety of settings, including private practice, hospitals, clinics, and rehabilitation centers, or they provide home health care for their patients. They may specialize in pediatrics (children), geriatrics (elderly), sports injuries, cerebral palsy, or mental illnesses. They may also teach or conduct research.

Physical therapy assistants help physical therapists in administering treatment to patients and maintaining documentation of a patient's progress. They usually interact more with the patients than the physical therapists, who are often overloaded with administrative duties and supervisory responsibilities.

Training to Be a Physical Therapist

A physical therapy program is typically a three-year, full-time program. It requires two to three years of prerequisite (required) undergraduate college courses that include biology, chemistry, and physics, before a student may apply for the program. Practical experience in the field as a physical therapy aide is also a requirement. Most programs offer a master's degree but some still only offer the bachelor's degree. In 2001, however, all programs will offer the master's degree.

In order to practice, a physical therapy graduate must pass a state licensing examination. Some states require continuing education to maintain a license. To keep up on the latest advances in the field, physical therapists should seek continuing education whether the state in which they are practicing requires it or not.

PHYSICIAN

Physicians are the foundation of all health care systems. Physicians diagnose and treat illnesses. Aside from helping patients overcome illness, physicians help people maintain good health with preventive care. Regular checkups from a family physician or pediatrician help people stay healthy. However, physicians do much more than simply provide physical examinations. They take medical histories and order, perform, and evaluate diagnostic (used in diagnosis) tests. If the tests show irregular results or indicate the presence of a disease, the physician will decide upon a course of treatment that may include medication, a surgical procedure, or therapy of some sort.

A SAMPLING OF SPECIALTIES

Here are just a few areas of medical specialty and what parts of the body they involve:

Anesthesiology: anesthesia or drugs used to make an individual lose consciousness/feeling (as when undergoing surgery)

Cardiology: the heart

Dermatology: the skin

Gastroenterology: the stomach and the intestines

Gynecology: the reproductive systems of women

Neurology: the brain and nervous system

Obstetrics: pregnancy and childbirth

Oncology: cancerous growths and tumors

Ophthalmology: the eyes

Orthopedics: the bones

Otolaryngology: ears, nose, and throat

Pathology: disease

Pediatrics: care of children

Psychiatry: the human mind and behavior

Pulmonary: lungs

Radiology: the use of radiation to treat disease

Thoracic: the midsection of the body

Urology: urinary tract

There are two different kinds of physicians and that difference lies in their training. The most common type of physician is a doctor of medicine (M.D.). M.D.s are also known as allopathic physicians. There is also the doctor of osteopathic medicine (D.O.). Both types of physicians use all accepted methods of treatment to treat patients; however, because of their training in osteopathy, D.O.s tend to pay closer attention to a patient's musculoskeletal (muscles

and bones) system and employ holistic (treating both the body and the mind) care.

Both M.D.s and D.O.s can specialize in a variety of areas. There are primary (initial) care specialties that include general internal medicine and general pediatrics. There are also what are categorized as medical specialties, such as cardiology, dermatology, obstetrics/gynecology, and pediatric cardiology. Surgery in and of itself is a specialty; there are general surgeons as well as surgeons who specialize in neurological surgery, plastic surgery, or thoracic surgery. Beyond these, there exist numerous other areas of specialty that include anesthesiology, emergency medicine, psychiatry, and radiology.

Approximately seven out of ten physicians work out of an office-based private or group practice. This can include health care clinics and HMOs (health maintenance organizations). When physicians work in a private or group practice, they will also have privileges to admit and supervise the care of their patients who require hospitalization and/or surgery. There are physicians who do not have outside practices and work on staff at a hospital. They are often known as attending physicians. Physicians can also be found working for the federal government, in government-funded hospitals and clinics, or for the Department of Health and Human Services. Most physicians who are on staff at hospitals that are associated with medical colleges also function as instructors at those colleges.

SPOTLIGHT ON PEDIATRIC CARDIOLOGY

Dr. Sean G. Levchuck is a pediatric cardiologist. He diagnoses and treats heart ailments in children from infancy through twenty-one years of age. Many of the heart problems that children suffer from are known as congenital (existing at birth) heart disease. In fact, eight out of every 1,000 children are born with a heart ailment. One of the most common ailments that pediatric cardiologists such as Dr. Levchuck treat are holes between the heart chambers.

Congenital heart disease can be treated with surgery, but often, a pediatric cardiologist can close the hole using a catheter (plastic tubing). Medication can also be used to treat congenital heart disease or to prevent arrhythmias (irregular heartbeats) from occurring. But, if the hole is too large to be treated with either of these techniques, a pediatric cardiologist will make sure the child is healthy enough to undergo surgery. A surgeon will then operate under the direction of the pediatric cardiologist to mend the hole in a child's heart.

In addition to seeing patients in a private office and making rounds in hospitals to check on the status of any patients he has admitted, Dr. Levchuck spends time in the cath lab, doing catheterizations on his patients. Catheterizing a patient enables Dr. Levchuck to open a closed valve in a child's heart or to simply get a better idea of what is happening in and around the heart.

Dr. Levchuck became a pediatric cardiologist because he found cardiology very interesting, especially congenital heart disease. And he loves helping children. To become a pediatric cardiologist, Dr. Levchuck went to medical school and then served a three-year residency in pediatrics. To specialize even further, he did a three-year fellowship in pediatric cardiology at a different hospital. He says that the hardest thing about his job is "the fact that some kids die; that's always the worst part." But, Dr. Levchuck says, "we can help everybody in some way, which is not how it has always been. Dramatic advances [in pediatric cardiology] have been made, especially in the last ten years."

There are only about 1,700 pediatric cardiologists in the world.

Physicians are often supported by physician assistants. Physician assistants are trained and certified to perform many duties that normally would be carried out by a physician, such as treating cuts and burns or setting broken bones. Physician assistants are also able to interpret lab tests, and they may even make preliminary diagnoses. Like physicians, physician assistants often specialize in a certain type of medicine, such as pediatrics or surgery. Physicians also work directly with nurses (see entry) and medical assistants, who perform clerical and organizational duties as well as assist doctors with procedures.

Training to Be a Physician

There is a great deal of education and training involved in becoming a physician of any type. First, an individual must earn a bachelor's degree with a focus on pre-medical studies. Toward the end of undergraduate studies, people wishing to enter medical school must take the Medical College Admission Test (MCAT). After gaining admission to a medical school, medical students then spend two years on classroom studies, taking courses such as anatomy and histology. The following two years are spent working in clinics and hospitals learning acute, chronic, preventive, and rehabilitative care under the supervision of physicians. Students rotate through different areas of care, such as internal medicine, psychiatry, and surgery in order to have a well-rounded knowledge of medical care.

After graduating from medical school, both M.D.s and D.O.s do internships (supervised practical experience) for one year. (Often, a M.D.'s internship will be considered the first year of residency.) The internship is followed by a residency (advanced training in a medical specialty) in a particular area, such as internal medicine or pediatrics, that can last two years or more. Physicians who wish to specialize even further, such as going into pediatric neurology, must do a fellowship (advanced study and research) that can be an additional three or more years. After this training is completed, physicians must pass a licensing exam. Beyond that, to become a certified specialist by the American Board of Medical Specialists (ABMS), an additional exam must be passed.

Because of the demanding nature of both the training and daily activities of physicians, individuals entering this field need to be very motivated and determined. In order to deliver quality care and truly help patients, physicians should have a good bedside manner (the ability to put a patient at ease and communicate effectively) and strong decision-making abilities.

PSYCHOLOGIST

Psychology is the study of behavior and the mind. There are many different types of psychology and many different kinds of psychologists. All psychologists are concerned, though, with some aspect of the behavior of an individual or an organization, or with the human or animal mind. When most people think of a psychologist, they think of a professional who diagnoses and treats mentally ill people. However, there are many psychologists who focus on research rather than actually treating individuals as practitioners do.

Working in laboratories or out of research centers, psychologists who conduct research can study anything from functions of the brain to the way large organizations, such as corporations, function. Some psychologists focus exclusively on the work habits and work environments of different people and are employed by privately owned businesses or the government. Other psychologists work in private practice, clinics, or hospitals with patients and clients to help those individuals overcome mental illness, such as attention deficit disorder or post-traumatic stress disorder. Psychologists are also instructors at universities, training others to become psychologists. And, a psychologist's role in education doesn't end there. Many psychologists work with students to help them with learning disabilities and violence prevention in schools. Finally, psychologists can be found working in and around a community, assisting in planning programs at community centers or providing counseling services within jails or juvenile-detention centers.

There is a wide range of specialties within psychology that individuals training to be psychologists can focus upon as they complete their training and prepare to enter the workforce:

CLINICAL PSYCHOLGIST. The most popular specialty in psychology, clinical psychologists interview, diagnose, and treat patients in a variety of settings, including counseling centers, private practices, hospitals, or universities. They are trained to provide individual, couples, family, and group therapy, all of which can help people overcome mental and emotional problems. Clinical psychologists are often instructors at colleges and medical schools.

DEVELOPMENTAL PSYCHOLGIST. Just as the name suggests, developmental psychologists are most concerned with the development of the human mind and behavior throughout a person's life. Developmental psychologists may focus their interests on research or treat persons who develop mental disorders during a particular time of development, such as infancy or adolescence. Specific developmental disabilities, such as mental retardation and autism, can also be a developmental psychologist's area of specialty.

INDUSTRIAL/ORGANIZATIONAL (I/O) PSYCHOLOGIST. Trying to improve productivity in the workplace, I/O psychologists use psychological principles and research to determine what motivates individuals and groups of people at work. I/O psychologists also work to improve the quality of work life so that both employee and employer are satisfied. Human resource specialists and trainers in the workplace are often trained I/O psychologists.

NEUROPSYCHOLOGIST. To be a neuropsychologist, one must first be a clinical psychologist. Because neuropsychologists concentrate on the relationship between the activities of the brain and a person's behavior, they often work with people who have suffered strokes or head injuries. Neuropsychologists also study the functions of memory as well as how certain diseases can affect people's emotions and behavior along with the rest of their mental functioning.

RESEARCH PSYCHOLOGIST. Human beings and animals, such as rats, monkeys, and pigeons, are often studied by research psychologists. Research psychologists usually work in university and private research centers as well as laboratories and for governmental organizations. They research and study things such as motivation, learning and memory, and the effects of substance abuse on the mind.

SOCIAL PSYCHOLOGIST. Working in settings as diverse as conducting research in a university or studying consumer likes and dislikes at an advertising agency, social pychologists study how people interact with others and the social environment. Social psychology research provides a greater understanding of how and why people form different opinions about certain people or things. This is especially helpful in overcoming problems like discrimination and prejudice.

SPORTS PSYCHOLOGIST. Athletes, both professional and amateur, must prepare both their bodies and their minds for a competition. Often, individual athletes or entire teams need help to become more mentally focused on goals or to become more motivated. Sports psychologists work with this population, helping athletes to achieve their goals. Along the way, the sports psychologist might also help an individual overcome anxiety and a fear of failure before an event or competition.

PSYCHIATRISTS VS. PSYCHOLOGISTS

Psychiatrists and psychologists are similar in that both are mental health care providers. The difference between the two lies in the training for each profession as well as their approaches to treating mental or behavior problems.

Psychiatrists are medical doctors. They attend college and go on to medical school just as all physicians do. After completing their schooling, psychiatrists do their residency in psychiatry, just as a pediatrician would do a residency in pediatrics. Psychologists go to college as well, but they go on to a graduate program where they earn a Ph.D. or a Psy.D. While psychologists do learn about the human body to a certain degree, they focus mainly on applying psychological principles when assessing and treating mental and developmental disorders. In contrast, psychiatrists, because they are physicians, focus on the biological and chemical causes behind mental illness as well as using psychological principles to diagnose and treat an individual.

Both of these types of mental health professionals can help people with mental illness or emotional and behavioral problems. Psychiatrists, however, are allowed to prescribe medications that are often used to treat anxiety, depression, or schizophrenia (see Chapter 12 Mental Illness). A psychologist treating an individual with any of these disorders would need to work closely with a psychiatrist in order to provide a patient with proper physical and psychological therapy.

Training to Be a Psychologist

Individuals working in the field of psychology usually hold bachelor's degrees (four-year college degree) in psychology. From there, an individual may choose to earn a master's degree in psychology and work as an I/O or a school psychologist. Clinical psychologists and other psychologists specializing in other areas usually hold doctorates of philosophy (Ph.D.) degrees in psychology. A doctor of psychology (Psy.D.) degree is also awarded at some universities.

A Ph.D. can take anywhere from five to seven years to complete. Near the end of the program, Ph.D. candidates must write a dissertation (an indepth research paper) based on original research that the student has conducted. A Psy.D. program is different in that it can often be based more on hands-on work and traditional exams rather than on a research-based dissertation. Most Ph.D. and Psy.D. students are also required to perform an internship.

Psychologists must be certified and licensed to practice psychology professionally. This certification and licensing usually involves passing written and oral exams.

RADIOLOGICAL TECHNOLOGIST

Radiological technologists are trained to take images of the inside of the human body. Some radiological technologists work with radiation to take these images. When most people hear the term radiation, they think of a harmful substance. While exposure to radiation can cause illness, small doses of radiation given in controlled settings can be helpful to doctors and patients. Radiation is used to create images, called X rays, of the inside of the body. Radiation, however, does more than produce images; it is also used to treat cancer.

The different types of radiological technologists include radiographers, radiation therapy technologists, and sonographers. Sonographers are unique in that they don't work with radiation. Rather, they use sound waves to take pictures of the human body. All radiological technologists work closely with radiologists, doctors specializing in radiology, who give them strict instructions for each patient. It's also important for radiological technologists to protect themselves and their patients from overexposure to radiation. Lead gloves, aprons, and equipment that monitors levels of exposure help to protect against overexposure to radiation.

RADIOGRAPHER. When doctors need to see the inside of the body to diagnose a medical problem, they order X rays, or radiographs, of a specific body part. Radiographers are responsible for producing these X rays.

First, radiographers explain to the patient how the procedure will work. Patients must remove any jewelry from their bodies, as X rays cannot pass through jewelry. Radiographers then position patients so that the X rays can reach the right part of the body and only that part. Finally, a lead shield is placed over the exposed body part to protect patients from radiation.

Once patients are positioned and protected, radiographers then measure the thickness of the body part being X-rayed. This allows radiographers to

set the X-ray machine at the right levels to release the right amount of radiation. Once the machine takes the picture, radiographers then develop the film for the doctor.

RADIATION THERAPY TECHNOLOGIST. Patients who are diagnosed with cancer sometimes receive radiation therapy to treat the disease. This involves getting certain doses of radiation from a radiation therapy technologist, or radiation therapist. Radiation therapists are trained to use equipment that releases radiation. Their jobs require extreme accuracy when giving treatments to patients. Once they have positioned patients properly, radiation therapists give specific doses of radiation to the affected body part, while also protecting the rest of the body from exposure.

Radiation therapy can cause patients to lose hair, feel nauseated, or experience skin problems. Radiation therapists are trained to help patients deal with these difficult side effects. Radiation therapy can also be emotionally difficult as many patients are struggling with cancer, which can be a life-threatening diseases. Radiation therapists and their patients usually develop a strong bond due to the intense nature of the treatment, which can last from a few weeks to many months.

SONOGRAPHER. Sonographers also take pictures of the inside of the body, but they use a different method that involves high-frequency sound waves. The sound waves are directed into the body and create echoes. Special equipment turns these echoes into images. Sonographers and patients can watch the images on a screen while the process takes place. Then a doctor views the images directly from the screen or from photographs that are taken by the sonographer. A diagnosis can be made from seeing the sonograph. Sonographers must also be extremely accurate when taking images of patients so that the doctor can make a diagnosis from examining the image.

Many sonographers specialize in certain parts of the body. For example, a sonographer who specializes in the female reproductive system will take sonographs of a baby in the womb as it grows to make sure it is healthy. Other specialties include the brain, the heart, the liver and kidneys, and the eyes.

Training to Be a Radiological Technologist

People interested in work as a radiological technologist can get training in a few different ways. These include programs in hospitals, vocational schools, colleges and universities, and the Armed Forces.

Programs offer either a certificate (one-year program), an associate's degree (two-year program), or a bachelor's degree (four-year program). Most people work toward an associate's degree. Certificate programs are for people who already have a medical background but wish to change careers. All programs, which require a high school diploma to enter, involve both classroom work and clinical instruction. While becoming registered with the American Registry of Radiologic Technologists (ARRT) is not required by law, most people like to hire those who are registered. Once a student has graduated from a radiological technologist program, it's necessary to pass an examination to become registered.

REGISTERED NURSE (R.N.)

There are many opportunities for those interested in a career as a registered nurse (R.N.). The many jobs available in the field continue to grow every year; in fact, nursing is one of the fastest growing occupations today. R.N.s not only treat patients who are sick, but they work to help people maintain good health as well as prevent and cope with illness and disease. While most R.N.s work directly with individual patients in different settings, they can also help entire communities improve health by acting as health care advocates for groups of people and families who are not receiving necessary medical care.

The basic duties of a R.N. are to:

• examine and record a patient's symptoms
• observe a patient's progress or a patient's reaction to treatment
• give medication to a patient
• assist doctors in the examination and treatment of a patient
• help with the patient's recovery

R.N.s usually work in hospitals. Most often, they are assigned to a specific area of the hospital, such as the pediatrics (children's) ward or the emergency room. However, R.N.s have many workplace options; they can work in a private doctor's office, as a home health nurse (caring for people in their homes), in a nursing home, with the government, in schools, in offices, or with health maintenance organizations (HMOs).

CERTIFIED NURSE-MIDWIFE (C.N.M.)

Midwives have existed for thousands of years giving women support and care through the birthing process. Even though midwives, or wisewomen as they were often called, have practiced for centuries, their profession was not officially recognized until recently. Midwifery as a formal profession began in 1921 when nurses who worked with the Frontier Nursing Service and Maternity Center Association saw that poor communities in New York City and Appalachia greatly needed their services because they couldn't afford to give birth in hospitals. Certified nurse-midwives (C.N.M.s) were officially recognized by the American College of Obstetricians and Gynecologists in 1971. Now, many hospitals employ C.N.M.s, who have been educated through graduate programs specializing in the birthing process, prenatal care, and aftercare for new mothers.

C.N.M.s offer women a safe, and often less costly, alternative to giving birth in a traditional hospital setting. They are committed to meeting the individual needs of their patients and giving women freedom to make choices during the birth, such as who will be present during the delivery and in what position the women want to give birth. While they are licensed to give drugs to their patients and provide patients with any technological assistance, C.N.M.s use technology only when it's absolutely necessary. Their mission is to give women a natural and normal birthing experience in a calm, caring atmosphere and to prevent any complications before, during, and after the birth.

The American College of Nurse-Midwives (ACNM) regulates the standards for C.N.M.s. All the schools that offer programs in nurse midwifery must be accredited by ACNM. All C.N.M.s must pass a national examination given by ACNM Certification Council.

C.N.M.s can work in many different settings. Some have their own practices, and some work with private doctors, hospitals, and birth centers. No matter where they work, C.N.M.s always work with a doctor, who remains available in case of a problem or emergency with the birth.

Some physicians are happy to cooperate with C.N.M.s and offer their assistance to them. However, other physicians may refuse to work with them because they don't agree with C.N.M.s' mission or are afraid of losing business to C.N.M.s. While C.N.M.s are licensed health care practitioners and covered by most insurance policies, they are relatively new as a formal profession compared with other health-related careers. At times, certain standards that the medical system has incorporated, such as a requirement to use certain technology during labor, make it difficult for C.N.M.s to do their jobs. Despite these obstacles, C.N.M.s are in high demand, and most women who use them choose to work with them again.

Working as a nurse can be very rewarding; however, like most jobs, there is stress involved. Many R.N.s spend most of the day on their feet. They also must deal with people's suffering on a daily basis. The amount of stress an R.N. experiences can depend on the setting in which the R.N. works. For example, an R.N. in the emergency room of a hospital may have more stress than an R.N. in a private doctor's office, as emergency room patients need immediate care. In addition, any R.N. in a hospital may have to work odd hours, as patients need to be cared for twenty-four hours a day. Most R.N.s at one point or another will work night shifts, as well as weekends and holidays.

Training to Be a Registered Nurse

In order to become an R.N., a person has three choices. These include earning an associate's degree (A.D.N.) through a junior or community college, which takes approximately two years; getting a diploma through programs offered in hospitals, which usually takes two to three years; and, finally, getting a bachelor of science degree in nursing (B.S.N.) at a university, which takes four to five years to complete.

While these three options are still acceptable, many state governments are now considering changing the requirements for an R.N.'s education. The new standards would require all R.N.s to have a B.S.N. It's beneficial now for all R.N.s to have a B.S.N. because it gives them greater opportunities in the field. Many R.N.s with a diploma or an associate's degree enroll in a bachelor's program, often having their employers pay for their schooling. All nursing education involves classroom work as well as practical experience in a hospital or other health care facility. After the schooling is completed, a person must take an examination to become a registered nurse.

Some R.N.s go on to do graduate work, which enables them to enter into specialized nursing fields, such as nurse practitioner (a nurse who is trained and licensed to act in place of a physician), certified nurse-midwife, or certified registered nurse anesthetist (who is responsible for anesthetizing a patient during an operation).

SOCIAL WORKER

The job of a social worker is a challenging one. They help people cope with many types of problems, including personal, family, and work-related issues. When people face financial problems, unemployment, serious physical or mental illness, disabilities, conflicts at school or on the job, social workers are there to guide them toward helpful resources and give them support through their difficult times. Social workers act as counselors and give special attention to the poor, who are unable to afford other types of counseling. Because they deal with so many problems, social workers often practice in several different environments. They can be found working in schools, hospitals, mental health clinics, welfare offices, and employment offices.

When people first meet with social workers for help, they talk oneon-one with the social worker about their problems. Social workers help their patients uncover their specific concerns and then review the possible solutions available to them. Because of their education and training, social workers may be able to offer solutions that their patients have never considered or weren't aware of. Finally, once a solution is agreed upon, social workers help their patients take action. This may involve helping patients fill out job applications or other types of forms and arranging for counseling services. By investigating the many resources that can help their patients, social workers can be instrumental in changing the course of their patients' lives.

The job of social workers can be very intense and emotional, as they often become intimately involved with their patients' lives. Social workers offer their services even after their patients are getting help from other sources for their problems. Through the follow-up care, social workers can ensure that the help their patients are receiving is the type of care they need. If something isn't working for their patients, social workers can direct them to a different service or program that may be more effective.

Almost all social workers specialize in a certain area:

• Family services social workers work with children and youths who are having trouble adjusting with an issue at home or at school.
• Child or adult protective services social workers investigate reports of abuse in the home. They take action to ease the problem or possibly take children or adults out of abusive homes and place them in safe homes or other facilities.
• Mental health social workers help people with mental or emotional problems cope with their daily lives.
• Health care social workers help people who are dealing with a serious or chronic illness, such as AIDS or Alzheimer's disease.
• School services social workers handle students' problems, such as pregnancy, bad behavior, or poor performance in school.
• Criminal justice social workers help convicted criminals and their families with court procedures and issues that arise after a person is released from prison.
• Occupational services social workers help people who have problems with their jobs, such as stress, or who have personal problems that are affecting their work.
• Gerontological services social workers deal with the concerns of elderly people and their families.

Training to Be a Social Worker

People who want to become social workers must have a bachelor's degree in social work (B.S.W.), which allows them to get an entry-level position in the field. This involves studying four years at a college or university whose program has been accredited by the Council on Social Work Education. In addition to classroom work, a student must have 400 hours of supervised training in the field.

JANE ADDAMS: PIONEER SOCIAL WORKER

Jane Addams (1860-1935) is considered a trailblazer of social reform. She dedicated her life to helping the poor and was responsible for starting one of the first settlement houses (a place that provides free services to communities) in the United States. Addams and her friend Ellen Starr established Hull House in Chicago, Illinois, in 1889 as a way to help poor and troubled families, as well as immigrants, who were living in the slums of the city. Addams worked and lived there until her death in 1935.

The seeds for planning Hull House were planted in Addams's head after a trip to Europe when she was a young woman. In London, she visited another settlement house called Toynbee Hall, where young women were helping poor people. One year after her return to America, she rented a house (the Hull mansion) and offered a variety of services, such as day-care centers for working mothers and recreational activities for children and teens. Through Addams's dedication and hard work, Hull House expanded with money from private citizens and grants from social agencies. Soon after its opening, Hull House became famous throughout the United States. It grew from one building to thirteen and offered medical care, legal aid, and English classes, as well as art, music, and drama instruction. By 1893, Hull House was helping more than 2,000 people each week.

The success of Hull House continued after Addams's death. Today, the original Hull House stands as a museum, but the Jane Addams Hull House Association continues to help many poor communities of Chicago.

For those who wish to work in the health or mental health area, it's necessary to have a master's degree in social work, which usually takes an additional two years of study, 900 hours of supervised training or an internship. A master's degree will also broaden the opportunities for social workers, allowing them to work in positions that supervise or train other people. All social workers must be licensed by the state in which they work; each state has its own requirements for licensing.

SPEECH-LANGUAGE PATHOLOGIST

Speech-language pathologists help people of all ages who have difficulty communicating. They treat people who stutter, have lost the ability to speak due to brain injury or brain disorder, have trouble speaking clearly, or have problems with the quality of their voice, meaning their voice is either too loud or too high. People who have hearing loss and speech problems because of emotional issues, or the inability to understand or produce language will also seek treatment from a speech-language pathologist.

With therapy and special equipment, speech-language pathologists evaluate patients, diagnose problems, and provide the appropriate treatment. Over the course of several weeks or even months, speech-language pathologists meet with patients and help them improve their voices, teach them to make certain sounds, and increase their language abilities. Sometimes, speech-language pathologists use a videostroboscopy, an instrument that allows them to view and monitor a patient's vocal chords for any abnormalities.

For both patients and speech-language pathologists, the therapy process requires patience, as it takes time to make significant progress. Sometimes, therapy is unsuccessful. With severe cases, speech-language pathologists may recommend an alternative to therapy. This includes sign language and devices, such as computers, that enable patients to communicate.

During treatment, speech-language pathologists may also work closely with parents or other family members to teach them how to cope with a loved one who has communication problems. They will also work with social workers or teachers, who can also help with a patient's progress and make sure the patient receives the best possible treatment.

Speech-language pathologists have many different job settings available to them. They may have their own private practice, while others may specialize in certain areas, working in schools with children, in hospitals with stroke victims, or in nursing homes or rehabilitation centers. Some speech-language pathologists are more interested in doing research than working directly with patients. They are usually employed at universities and study the origins of speech problems, as well as the impact of communication disorders on patients. They may also develop new techniques, equipment, or drugs to treat patients.

Training to Be a Speech-Language Pathologist

Becoming a speech-language pathologist requires a master's degree in speech-language pathology from a university that is accredited by Educational Standards Board of the American Speech-Language-Hearing Association. A master's degree involves classroom work, as well as 350 hours of practical experience. And, most states require speech-language pathologists to become licensed. To get a license to practice speech-language pathology, a graduate must pass a written exam, complete 375 hours of practical experience supervised by another licensed speech-language pathologist, and complete at least thirty-six weeks of professional experience in the field. Some states require that speech-language pathologists continue their education every few years in order to renew their license.

FOR MORE INFORMATION

Books

Baxter, Neale and Philip A. Perry. Opportunities in Counseling and Development Careers. Lincolnwood, Ill.: VGM Career Horizons/NTC Publishing Group, 1997.

Camenson, Blythe. Real People Working in Health Care. Lincolnwood, Ill.: VGM Career Horizons/NTC Publishing Group, 1997.

Field, Shelly. Career Opportunities in Health Career: A Comprehensive Guide to Exciting Careers Open to You in Health Care. New York: Facts on File, Inc., 1997.

Krumhansl, Bernice. Opportunities in Physical Therapy Careers. Lincolnwood, Ill.: VGM Career Horizons/NTC Publishing Group, 1993.

Lund, Bill. Getting Ready for a Career in Health Care. New York: Capstone, 1998.

The Occupational Outlook Handbook 1998-99. Compiled by the United States Department of Labor, 1998.

Reeves, Diane Lindsey. Career Ideas for Kids Who Like Science. New York: Facts on File, Inc., 1998.

Shafer, R.C. and Louis Sportelli. Opportunities in Chiropractic Health Care Careers. Lincolnwood, Ill.: VGM Career Horizons/NTC Publishing Group, 1994.

Weeks, Zona R. Opportunities in Occupational Therapy Careers. Lincolnwood, Ill.: VGM Career Horizons/NTC Publishing Group, 1996.

Web sites

American Art Therapy Association. [Online] www.arttherapy.org (Accessed August 21, 1999).

American Association of Colleges of Pharmacy. [Online] http://www.aacp.org (Accessed August 21, 1999).

American Association of Oriental Medicine. [Online] http://www.aaom.org (Accessed August 21, 1999).

American Chiropractic Association. [Online] http://www.amerchiro.org (Accessed August 21, 1999).

American Counseling Association. [Online] http://www.counseling.org (Accessed August 21, 1999).

American Dental Association. [Online] http://www.ada.org (Accessed August 21, 1999).

American Medical Association. [Online] http://www.ama-assn.org (Accessed August 21, 1999).

American Nurses Organization. [Online] http://www.nursingworld.org (Accessed August 21, 1999).

American Occupational Therapy Association. [Online] http://www.aota.org (Accessed August 21, 1999).

American Optometric Association. [Online] http://www.aoanet.org (Accessed August 21, 1999).

American Physical Therapy Association. [Online] http://www.apta.org (Accessed August 21, 1999).

American Psychiatric Association. [Online] http://www.psych.org (Accessed August 21, 1999).

American Psychology Association. [Online] http://www.apa.org (Accessed August 21, 1999).

American Society of Radiologic Technologists. [Online] http://www.asrt.org (Accessed August 21, 1999).

American Speech-Language-Hearing Association. [Online] http://www.asha.org (Accessed August 21, 1999).

Association for University Programs in Health Administration. [Online] http://www.aupha.com (Accessed August 21, 1999).

National Association of Emergency Medical Technicians. [Online] http://www.naemt.org (Accessed August 21, 1999).

National Association of Social Workers. [Online] http://www.socialworkers.org (Accessed August 21, 1999).